Rare diseases

Sulfasalazine shows promise as a potential treatment for IgA-vasculitis

Sulfasalazine is a potential treatment for IgA-vasculitis (Henoch-Schönlein Purpura), according to Russian researchers who tested the drug in a small trial and found that most patients experienced complete remission of arthritis and skin rash.

Dr Sergei Giliaev and colleagues from the First Moscow State Medical University decided to investigate sulfasalazine in patients with IgA-vasculitis because it shares many clinical, endoscopic, and radiological signs with inflammatory bowel disease (IBD).  They hypothesised that the two conditions may have a common pathogenetic background for both pathological conditions: sulfasalazine (SASP) is known to improve symptoms in IBD, but they were unaware of any trials of the drug in IgA-vasculitis.

Their study included 78 adult patients with primary IgA-vasculitis diagnosed using EULAR/PRES criteria. Patients were started on 1 g/daily sulfasalazine, which was titrated up to 2 g/day depending on tolerability and clinical response. Sice the start of the trial, most patients (96%) have been taking sulfasalazine for more than six months and more than half (56%) for longer than a year. The longest treatment is five years.

Complete clinical remission of the skin rash was achieved in 48 patients (58.9%) and a further 27 patients (35%) saw partial improvement in skin eruptions (fewer skin purpura or longer periods symptom free). Only four patients showed no skin improvement.

In terms of arthritis/arthralgia, 41 patients (85%) achieved persistent remission and only one patient showed no improvement at all. Complete resolution of urinary abnormalities was seen in 14 patients (40%), 17 others (48.5%) experienced some improvement, but four (11.5%) experienced deterioration.

The study was flagged as a clinical highlight of EULAR 2018 by Professor John Isaacs, consultant rheumatologist at the Freeman Hospital, Newcastle, UK and Director of the Institute of Cellular Medicine at Newcastle University.

While not a blinded or a controlled study, he said, it had produced some “very good results” and he hoped that it would lead to a larger more robust study.

“I have a few patients with condition and it is difficult to treat actually,” he said. “This could be useful as something to look at.”

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